Qureos Mentor

Orange Health Consultancies 

Pay: 2,500.00 (AED)-4,000.00 (AED) per monthJob Description:Job PurposeTo support the design, coordination, and execution of wellness initiatives for corporate clients, while also managing the end-to-end processing and support of health insurance claims. This dual-function role ensures seamless service delivery in both wellness and claims, aligned with UAE insurance regulations and client expectations.Key Responsibilities &amp; DutiesWellness Program Support&middot; Assist in the design and coordination of wellness programs tailored to client needs.&middot; Facilitate wellness sessions including health screenings, fitness events, mental health workshops, and awareness campaigns.&middot; Maintain wellness calendars and manage the execution of scheduled events.Client &amp; Stakeholder Engagement&middot; Serve as the primary liaison between client HR teams, wellness service providers, and TPAs.&middot; Provide regular updates to clients on wellness engagement levels and claims performance.&middot; Address inquiries and escalate complex matters to relevant internal teams.Wellness Monitoring &amp; Reporting&middot; Track wellness program participation rates and compile performance reports.&middot; Analyze program effectiveness using KPIs and employee feedback.&middot; Support the preparation of dashboards and reports for client presentations.Claims Handling &amp; Adjudication Support&middot; Review claim submissions to ensure accuracy, completeness, and adherence to policy terms.&middot; Coordinate with TPAs and internal claims units for timely approvals, rejections, and clarifications.&middot; Support pre-authorization requests and follow up with healthcare providers for required documentation.Claims Dispute &amp; Resolution&middot; Investigate claim rejections and support the appeals process where applicable.&middot; Resolve client and employee concerns regarding delayed or denied claims.&middot; Escalate unresolved disputes to the Claims Supervisor or insurer.Benefit Verification &amp; Policy Support&middot; Verify coverage eligibility and benefit limits before processing high-value or complex claims.&middot; Educate client HR teams on policy inclusions, exclusions, and claims processes.Vendor &amp; Provider Coordination&middot; Schedule and manage services with external wellness vendors and healthcare providers.&middot; Foster strong working relationships with TPAs and clinics to ensure smooth claims processing and wellness delivery.&middot; Monitor service levels and turnaround times (TATs), raising concerns as needed.Communication &amp; Awareness&middot; Develop and distribute wellness and claims communication materials (e.g., posters, emails, FAQs).&middot; Promote employee awareness of wellness benefits and claims filing procedures through campaigns.&middot; Maintain wellness and claims documentation for internal and external communication.Training &amp; Knowledge Building&middot; Organize training sessions for employees and HR teams on wellness tools and insurance claim filing.&middot; Stay updated on industry trends, wellness innovations, and UAE insurance regulations.&middot; Contribute new ideas to improve employee engagement and claims efficiency.Compliance &amp; Audit Support&middot; Ensure compliance with DHA/HAAD regulations and internal claims and wellness procedures.&middot; Maintain accurate records of claims and wellness activities for audits.&middot; Assist in preparing compliance reports and responding to audit queries.Daily DutiesPrimary&middot; Coordinate logistics for wellness activities and health events.&middot; Review and follow up on claim submissions and approvals.&middot; Maintain dashboards and reports for both wellness and claims performance.&middot; Handle basic client queries related to wellness and claims.Secondary&middot; Create wellness content for newsletters and internal platforms.&middot; Support onboarding of new clients in wellness and claims-related areas.&middot; Participate in internal team initiatives aligned with HR and employee benefits.Required Skills &amp; CompetenciesTechnical Skills&middot; Knowledge of wellness program planning and insurance claims processing.&middot; Familiarity with UAE healthcare regulations (DHA/HAAD).&middot; Proficiency in Microsoft Office Suite (Excel, PowerPoint, Outlook).&middot; Experience with TPA portals or claims platforms (preferred).Soft Skills&middot; Excellent communication and interpersonal skills.&middot; Strong time management and coordination abilities.&middot; Analytical mindset with attention to detail.Core Competencies&middot; Teamwork: Collaborate with internal departments, TPAs, and clients effectively.&middot; Customer Focus: Deliver prompt and supportive responses to client wellness and claims needs.&middot; Problem Solving: Proactively address client issues and suggest improvements.&middot; Adaptability: Adjust to evolving client requirements and regulatory updates.Educational QualificationsEssential&middot; Bachelor&rsquo;s degree in Healthcare, Insurance, Human Resources, or a related field.Preferred&middot; Certification in Health &amp; Wellness, Insurance Claims Management, or similar.&middot; Training in Mental Health Awareness, Wellness Coaching, or Employee Engagement.&middot; CII, LOMA, or other insurance certifications (advantageous).Knowledge Requirements&middot; Familiarity with corporate wellness strategies and mental health initiatives.&middot; Understanding of UAE health insurance practices, claims procedures, and compliance norms.&middot; Awareness of wellness ROI measurement and employee engagement techniques.Job Type: Full-timeJob Type: Full-timePay: AED2,500.00 - AED4,000.00 per month

Operations Executive - Corporate Wellness

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Orange Health Consultancies

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Operations Executive - Corporate Wellness